In a recently released issue of Pediatrics, Dr. Fallon Cook and Australian colleagues (10.1542/peds.2018-0977) present a fascinating study about the 5 and 11 year old mental health outcomes of infants who had “regulatory problems” at age 12 months. Using validated measures, the researchers queried mothers about the sleeping, eating and crying habits, and temperaments, of their 12 month old infants. 1759 mothers were enrolled in this large prospective community-based study, and at 5 and 11 years, 1002 (60%) and 871 (49%) of the initial cohort remained, respectively, who then completed the Strengths and Difficulties Questionnaire, which has been shown to be a reliable and valid measure to identify children who meet DSM-4 (Diagnostic and Statistical Manual Fourth Edition) criteria for needing psychological treatment.
The research team identified 5 “infant regulation profiles” ranging from “settled,” which described those with very few problems (36.8% of the group), all the way to “severely unsettled,” describing those with moderate to severe sleep problems, crying, temper tantrums and feeding issues (3.4% of the group). Mothers of “severely unsettled” as compared to “settled” infants were more likely to have “severe mental distress.” You will want to read the fascinating findings in detail to understand the nuances of outcomes at ages 5 and 11 years of infants with varying degrees of dysregulation profiles, compared to those infants with “settled” profiles. The small group described as “severely unsettled” had especially high risk of later mental health concerns.
This information is good news and bad news for practicing pediatricians. On one hand, it may give insight into those mother-infant dyads for whom one just cannot seem to provide the right advice. It seems possible that much more is going on with these babies than simple pediatric problems gone awry with failed advice. On the other hand, it doubles down on the need to listen carefully and respectfully to the parents of very difficult babies and toddlers, because early referral to experienced infant and toddler mental health professionals may be key. There is so much more to understand. Even with careful and thoughtful studies such as this one, many stones remain unturned. The research examined maternal characteristics, including whether mothers were partnered, but details regarding maternal depression and mental health diagnoses, paternal characteristics, and the parental (or other caregivers’) relationship may be important here too. The British pediatrician and psychoanalyst, Dr. Donald Winnicott, famously said, “There is no such thing as an infant', meaning, of course, that whenever one finds an infant one finds maternal care, and without maternal care there would be no infant…” 1; we would certainly now include the care of the father in this statement. So the main point I took home is that the fascinating work of Dr. Cook and colleagues sheds some light on how critically important the parental report of a “difficult baby” may be, and on the need to listen well and respond, because the infant’s future may be at stake.
1. Winnicott, D.W. The Theory of the Parent-Infant Relationship. Int. J. Psycho-Anal., 1960; 41:585-595.